Provider Demographics
NPI:1366425001
Name:LIBERT, LORI A (PT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:LIBERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 NW 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-2263
Mailing Address - Country:US
Mailing Address - Phone:352-376-1320
Mailing Address - Fax:352-376-1340
Practice Address - Street 1:2730 NW 39TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-2263
Practice Address - Country:US
Practice Address - Phone:352-376-1320
Practice Address - Fax:352-376-1340
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UZ107ZMedicare ID - Type Unspecified